AB1482 PROGNOSTIC FACTORS FOR TUBERCULOUS SPONDYLODISCITIS
Authors: M. Mrabet, S. Boussaid, S. B. Troudi, S. Rekik, S. Jemmali, S. Rahmouni, H. Ajlani, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2022)

Background Tuberculous spondylodiscitis (SPDT) or Pott’s disease is an infectious involvement of the disc-vertebrate couple, caused by the tubercular bacillus (Mycobacterium tuberculosis). It accounts for 46% to 64% of infectious spondylodiscitis and is the most common form of vertebral tuberculosis. Pott’s disease still poses a public health problem in Tunisia due to the endemicity of tuberculosis and the increase in extra-pulmonary forms. Objectives Our aim was to study factors impacting SPDT outcome. Methods We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. The diagnosis was based either on a range of highly evocative clinical, biological and radiological arguments or on the disco-vertebral biopsy puncture. The study included correlations of the promoting factors of SPDT (tuberculosis infection, history of tuberculosis, diabetes, corticosteroids and trauma), epidemiological, clinical, biological, radiological and therapeutic data with good clinical outcome in the fourth week of the anti-tuberculosis drugs treatment. Results Fifty-two cases of SPDT were collected (37F/15M). The mean age was 55.21±17.79 years [19-91]. Thirty-three patients (69.2%) were aged under 65 years versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). The diagnosis of SPDT was based either on a range of highly evocative clinical, biological and radiological arguments (71.2%) or on the disco-vertebral biopsy puncture (28.8%). Among the clinical arguments suggestive of tuberculous SPD were: progressive onset of symptoms in 47 patients (90.4%), segmental spinal stiffness in 37 patients (71.2%), spinal pain with general signs of tuberculosis such as impaired general condition, fever, night sweats and weight loss in 32 patients (61.5%). Lumbar spine involvement was the most common in tuberculous SPD (57.7%). A biological inflammatory syndrome has been objectified in 38 patients (73.1%). Imaging was contibutive to positive diagnosis using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs. The treatment was based on anti-tuberculosis drugs for at least nine months. Only four factors had an unfavourable predictive value (p ≤ 0.05): Normochromic normocytic anemia observed in 53.8% of our patients (p = 0.018; Odds Ratio = 6.66), initial lymphocytosis (p = 0.048), fever in 36.5% of our patients (p = 0.01; Odds Ratio = 9.6) and standard X-ray vertebral compression in 67.3% of our cases (p = 0.001; Odds Ratio = 13). Conclusion Tuberculous spondylodiscitis is a frequent condition that needs to be diagnosed and treated rapidly. Poor prognosis factors have been identified to provide insight into disease progression. Disclosure of Interests None declared